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Anabolengebruik is opstap voor verslaving aan heroïne
Een grote groep verslaafden van opiaten heeft eerst anabole steroïden gebruikt. Dat zegt de Amerikaanse
psychiater Harrison Pope in zijn laatste publicatie. Pope denkt dat het anabolengebruik kan dienen als opstapje voor
serieuze verslaving.
In het onderzoek, dat binnenkort verschijnt in de Journal of Clinical Psychiatry, kijken Pope en zijn medewerkers naar
223 mensen die in een centrum worden behandeld voor hun verslaving aan alcohol, coke of opiaten.
Bij de ex-gebruikers van opiaten - heroïne, Nubain, maar ook pijnstillers als Percocet en OxyContin - bleek er
sprake van een verband met het gebruik van spierversterkers. Een kwart van de 88 afkickende opiaatverslaafden had
in het verleden wel eens anabolen gebruikt. Bij de alcoholverslaafden was dat maar vijf procent.
De studie geeft een aantal aanwijzingen over de aard van het verband. Van de 24 anabolengebruikers die later
opiaten ging gebruiken waren er zeven die hun eerste opiaten van hun anabolendealer hadden gekocht. Achttien
gebruikers hadden zich daarnaast op de sportschool leren injecteren.
Pope denkt echter dat er meer aan de hand is. Hij gelooft dat het gebruik van anabolen de hersenen verandert, zodat
die gevoeliger worden voor harddrugs. Een andere mogelijkheid, zegt Pope, is dat bodybuilders misschien psychologische
eigenschappen hebben waardoor ze sneller verslaafd raken.
For Some, Anabolic Steroids May Lead to Hard Drugs.
Reuters, 24-3-2003. Gebaseerd op Journal of Clinical Psychiatry 2003;64:156-160.
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Steroid Use Linked to Addiction
The trouble with addiction started as he tried to get off
steroids, Tony recalled. "When I came off them, I never got my energy back",
the bodybuilder said. "For me, it took a few months to feel I had a backbone."
So the fellow bodybuilder who had supplied him with illegal steroids was now
illegally offering him other drugs, including Nubain and Percocet, both prescription
painkillers, said Tony, a Boston-area man who spoke on condition of anonymity.
He had bulked up on steroids, but felt he could not lose enough fat to win
bodybuilding competitions. The other drugs were supposed to help him readjust
to life without steroids, Tony said.
What he didn't realize, he said, is that Nubain and Percocet could also lead
to addiction. The drugs have similarities to morphine, though Nubain is considered
to have less addictive potential.
"I'm not using them now, but I do crave them", Tony said. He is getting
treatment from Dr. Harrison G. Pope, chief of the Biological Psychiatry Laboratory
at Harvard-affiliated McLean Hospital in Boston.
Nubain is not supposed to be nearly as addictive as morphine, but his
previous research indicates bodybuilders are getting hooked, Pope said.
And a letter in The New England Journal of Medicine indicates that
steroids may lead some bodybuilders into harder drugs. "Steroids may
serve as `gateway' drugs to opiod dependence", wrote Pope and
Drew Arvary, a substance abuse counselor at Sunrise House, an in-patient
dependence treatment facility in Lafayette, N.J.
Pope and Arvary looked at 227 men admitted for dependence on heroin or
similar drugs in 1999. They found 9.3 percent had a history of steroid use.
In contrast, among 197 similar admissions in 1990, only .5 percent reported steroid use.
The men indicated they were introduced to the harder drugs through the
bodybuilding community, the letter said. Eighty-one percent of the 1999
patients bought both drugs from the same supplier, it said.
And the men said they used the drugs to deal with steroid-related
problems such as irritability while on steroids or depression after
they gave up steroids, the journal letter said.
"It's almost become the same now — the drug culture is the
gym culture", Arvary said. Steroids themselves are not physically
addicting but, when users go off the drugs, the shrinkage of muscle
can be hard to handle, Arvary said. "They don't feel pumped; they don't
feel their muscles are full", he said. "The only way they can go out
to function is some kind of narcotic — mainly heroin, in this case."
The patients who went from steroids to heroin were hard to keep
off drugs later, the letter said. "In the 1 to 11 months since their
discharge from Sunrise House, 17 have relapsed into opiod use, and
2 have committed suicide", it said.
Former steroid and opiod users are even harder to treat than opiod
users alone, Arvary said. The ex-bodybuilders refuse to class themselves
with frail addicts who they picture as 'sleeping in the streets', he said.
"It's almost dealing with a perfectionistic type of behavior where they feel
they are better than them."
As a result, addiction groups tend not to work with these patients,
who need one-on-one counseling, Arvary said.
The letter acknowledged several limitations. For one, the findings
cannot prove that steroid use in itself led to use of the harder drugs.
However, although the drugs are not similar, other studies have indicated
the two drugs might effect the brain in similar ways, Pope said.
Steroid users get 'a withdrawal effect' when given drugs used to help
heroin or morphine users with withdrawal, he said.
The letter gives rise to interesting speculation, but should serve only
as an indication that the issue deserves further study, said Charles Yesalis,
a Penn State researcher who was not connected with the Pope-Arvary project.
He had reported earlier that steroid users had a higher likelihood of
using other drugs. But as for a cause-effect relationship, "We are not even
within five miles of articulating that", Yesalis said.
AP, 21-5-2000.
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Anabolic-Androgenic Steroids as a Gateway to Opioid Dependence
Athletes who abuse anabolic-androgenic steroids may go on to abuse opioid
agonist-antagonists such as nalbuphine or even classic opioids such as heroin.
We studied this phenomenon among patients treated at Sunrise House, a private
inpatient facility for substance-dependence treatment in northern New Jersey.
Among 227 men admitted for dependence on heroin or other opioids in 1999, we found that
21 (9.3 percent) had a history of anabolic-androgenic steroid use. In contrast, among
197 men admitted for opioid dependence in 1990, only 1 (0.5 percent) reported prior
use of anabolic-androgenic steroids).
None of the 21 men in 1999 reported any form of substance abuse or dependence before
their use of anabolic-androgenic steroids. The mean (±SD) age at the time of their
first use of anabolic-androgenic steroids was 20.9±2.4 years and the age at the
time of their first use of opioids was 27.0±4.0 years. The information they provided
strongly suggests that they were introduced to opioids through anabolic-androgenic steroid
use and the bodybuilding subculture: 17 of the 21 men (81 percent) first purchased opioids
from the same drug dealer who had sold them anabolic-androgenic steroids; 14 (67 percent)
were introduced to opioids by a fellow bodybuilder; 18 (86 percent) claimed that they
first used opioids to counteract insomnia and irritability induced by anabolic-androgenic
steroids; and 14 (67 percent) had used opioids to counteract depression associated with
withdrawal from anabolic-androgenic steroids. All 21 of the men reported at least one
of these four attributes.
Demographically, these men appeared atypical for opioid users; they all lived in
suburban New Jersey and reported a mean household income of $69,800 (range,
$38,000 to $145,000). They reported serious associated morbidity. Since the time
of their first use of opioids, 15 (71 percent) had been charged with possession of a
controlled substance or prescription fraud; 5 (24 percent) had served time in prison,
including 1 for attempted murder; and 7 (33 percent) had made at least one suicide attempt.
In the 1 to 11 months since their discharge from Sunrise House, 17 (81 percent) have
relapsed into opioid use, and 2 (10 percent) have committed suicide.
These findings suggest an alarming trend: that anabolic-androgenic steroids may serve
as "gateway" drugs to opioid dependence, with substantial associated morbidity and
even mortality. Although our study cannot establish that anabolic-androgenic steroid use
per se led to opioid dependence in these men, the data we report strongly suggest this
interpretation. Alternatively, what we observed might be specific to our facility, but
our facility is in a region not noted for unusually high rates of either anabolic-androgenic
steroid use or opioid dependence. Progression from anabolic-androgenic steroid use to
opioid dependence deserves further exploration as a public health problem.
Drew Arvary
Sunrise House
Lafayette, NJ 07848
Harrison G. Pope, Jr., M.D.
Harvard Medical School
Boston, MA 02115
New England Journal of Medicine, 18-5-2000.
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[Definitie:] "An ergogenic aid is any substance or phenomenon that enhances performance."
(Wilmore and Costill) 
